Provider Demographics
NPI:1447282512
Name:STRICKE, LESLIE MALVIN (MD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:MALVIN
Last Name:STRICKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8631 W 3RD ST
Mailing Address - Street 2:735
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5901
Mailing Address - Country:US
Mailing Address - Phone:310-657-4170
Mailing Address - Fax:310-657-8909
Practice Address - Street 1:8631 W 3RD ST
Practice Address - Street 2:735
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5901
Practice Address - Country:US
Practice Address - Phone:310-657-4170
Practice Address - Fax:310-657-8909
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA31768207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA26596Medicare UPIN